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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Association Between Social Determinants of Health and Severity of Traumatic Brain Injury in Children: A Retrospective
Justin C Wilburn1, Abbas H Zaidi2, Lori A Gurien3
1Department of Obesity and Cardiovascular Research, Nemours Children's Health, Jacksonville, FL, USA.
Insights
Social determinants of health, including race and Child Opportunity Index (COI), significantly impact pediatric traumatic brain injury (TBI) severity and outcomes in the Southeast US. Black children and those with lower COI experienced worse outcomes, highlighting critical health disparities.
Area of Science:
- Pediatric Traumatology
- Public Health
- Health Disparities Research
Background:
- Traumatic brain injury (TBI) is a major cause of childhood morbidity and mortality in the US.
- Social determinants of health (SDOH) and regional factors influence TBI severity and outcomes.
- Limited data exist on SDOH, race, and Child Opportunity Index (COI) impact on pediatric TBI in the Southeast US.
Purpose of the Study:
- To investigate the impact of SDOH, including race, sex, and COI, on pediatric TBI severity.
- To analyze TBI outcomes such as length of hospital stay (LOHS), intensive care unit stay (LOICUS), and craniotomy rates.
- To identify health disparities in pediatric TBI care within the Southeast US.
Main Methods:
- Retrospective analysis of 1063 pediatric TBI cases admitted to a Level I Pediatric Trauma Center (2017-2023).
- TBI severity assessed using the Glasgow Coma Scale (GCS).
- Patients categorized by race (White, Black, non-Black people of color [NBPOC]), COI (low, moderate, high), and sex; analyzed using chi-square tests and ANOVA.
Main Results:
- Significant racial and COI-based disparities in TBI severity and outcomes were observed.
- Black children and those with low COI exhibited lower GCS scores and longer LOHS/LOICUS compared to White children and those with high COI.
- Black and NBPOC children had higher rates of craniotomy than White children; no sex-based differences were found.
Conclusions:
- Race and COI are significant social determinants influencing pediatric TBI severity, interventions, and outcomes.
- The study reveals critical healthcare disparities affecting vulnerable pediatric populations with TBI.
- Targeted interventions are necessary to address and mitigate these identified health inequities.
Abstract:
BackgroundTraumatic brain injury (TBI) is a leading cause of morbidity and mortality among children in the United States (US), with severity and outcomes linked to social determinants of health (SDOH) and regional differences. Data on the impact of SDOH including race, sex, and Child Opportunity Index (COI) level on TBI severity in southeastern US are sparse in children.MethodsWe analyzed data retrospectively in 1063 children with TBI, admitted at a Level I Pediatric Trauma Center in the Southeast US between January 2017-June 2023. TBI severity was categorized using the Glasgow Coma Scale (GCS). Outcomes were length of hospital stay (LOHS), intensive care unit stay (LOICUS), and craniotomy frequency. Patients were classified by race (white, Black, non-Black people of color [NBPOC]), COI (low, moderate, high), and sex (male, female). Statistical analyses included chi-square tests, one-way analysis of variance (ANOVA), and post-hoc comparisons.ResultsSignificant disparities were observed by race and COI. Black children and children with low COI had lower GCS scores (P < 0.01), longer LOHS and LOICUS (P < 0.01) compared to white children and those with high COI. Additionally, Black and NBPOC children were more likely to undergo craniotomies than white children (P < 0.05). No sex-based differences in TBI severity or outcomes were found.DiscussionThis study highlights the significant impact of SDOH, particularly race and COI, on pediatric TBI severity, surgical interventions, and outcomes. These findings underscore the need for targeted interventions to address health care disparities in vulnerable pediatric populations.
